Preserving Your Fertility

Uterine fibroids, those benign tumors that grow inside, just outside, or within the lining of the uterus, can cause a lot of trouble: vaginal bleeding, pelvic pain, and infertility. But women in the childbearing years may suffer through without treatment because they are concerned that the cure will rob them of their fertility.

A study published in The Female Patient talked about the work of the physicians at Philadelphia's Thomas Jefferson University Hospital in relation to a 35 year-old woman whose fibroids were so numerous they created a large mass in the area of her pelvis. During her initial diagnosis, physicians said the size of the mass could be compared to a pregnancy at term.

"Traditionally, treatment for such a large fibroid mass in the uterus has been limited to hysterectomy, because the patient would bleed extensively if an attempt was made to merely remove the fibroids." says lead author of the study Jay Goldberg, M.D., MSCP. Goldberg is the director of the University's Jefferson Fibroid Center. "In this particular case though, hysterectomy was not an option because the patient strongly desired future fertility and uterine preservation."

A Plan!

Hoping to honor the wishes of their patient that her fibroids rather than her womb be removed, the physicians devised a plan that involved performing two procedures four weeks apart.

The physicians at Jefferson began by performing UFE (uterine fibroid embolization). This procedure is considered to be minimally invasive. Performed by radiologists, the technique involves blocking the arteries that feed blood to the fibroids. The physicians hoped that this unique procedure would serve to reduce the flow of blood within the patient's uterus to minimize the chance of hemorrhaging as a complication.

Four weeks later, the patient was given an abdominal myomectomy. In a myomectomy, the fibroids are taken out by way of an incision in the skin of the abdomen.

Only 34?

Due to the earlier UFE procedure, physicians found that the size of her uterus had been reduced from that of 38-weeks gestation to a 34-week size. There was much less blood flowing to the area. The surgeons were able to remove 11 large fibroids during the myomectomy procedure and there was only minimal blood loss. Recovery was so quick that the patient was released from the hospital 2 days after the surgery. There were no complications.

Dr. Goldberg, also the director of the university's Division of General Obstetrics, and his physician team gave a hearty recommendation of the combination of these two procedures for women who still want to keep their uteruses. "We are noting a trend toward more women requesting uterine-preserving treatment for fibroids—even with massively enlarged uteri, and even when future fertility may not be a consideration," read the report.